Provider Demographics
NPI:1033222617
Name:SHREVE, RONALD LANE (DDS)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:LANE
Last Name:SHREVE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17535 ROSBOUGH DR.
Mailing Address - Street 2:#203
Mailing Address - City:MIDDLEBURG HTS.
Mailing Address - State:OH
Mailing Address - Zip Code:44130
Mailing Address - Country:US
Mailing Address - Phone:440-243-8888
Mailing Address - Fax:440-243-4575
Practice Address - Street 1:17535 ROSBOUGH DR.
Practice Address - Street 2:#203
Practice Address - City:MIDDLEBURG HTS.
Practice Address - State:OH
Practice Address - Zip Code:44130
Practice Address - Country:US
Practice Address - Phone:440-243-8888
Practice Address - Fax:440-243-4575
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH172831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice